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CITY Revised 07-25-2014 <br /> • <br /> TRANSPORTATION BENEFIT DISTRICT(TBD) DOL Contract No. K5155 <br /> II §xi0 A;rT`:x Wit'g *T:.Pv3 <br /> .�- LICENSING DISCLOSURE AGREEMENT TBD Contract No <br /> Upon execution, this Contract is entered into by and between Washington State, Department of Licensing (hereinafter <br /> called "DOL"or"Department"), and the Everett Transportation Benefit District(hereinafter called"TBD" or <br /> "Contractor") listed below. <br /> Contract Start Date Contract End Date Contractor Amount <br /> Date of execution Extend through the life of the TBD 1%of each $20.00 fee collected <br /> Purpose(brief description) <br /> The purpose of this contract is to provide the terms and conditions under which DOL shall administer and collect fees I <br /> on behalf of cities who have established a Transportation Benefit District(TBD) in order to provide the funding for <br /> transportation improvements within the TBD's area. <br /> CONTRACTOR CONTACT INFORMATION <br /> Contractor Name Contractor DBA or FKA <br /> Everett Transportation Benefit District - <br /> Contractor Address Uniform business identifier(UBI) Employment Identification Number(EIN) _I <br /> 3200 Cedar St., Everett WA 98201 3130000656 91-6001248 '� <br /> TBD Contract Manager TBD Phone Contractor Fax Contractor E-Mail Address <br /> Richard Tarry 425-257-8922 425-257-8882 rtarry@everettwa.gov <br /> Contractor Additional Contact#2 Contact#2 Phone Contact#2 Fax Contact#2 E-Mail Address --cJ <br /> Matt Welborn 425-257-8974 425-257-8882 mwelborn@everettwa.gov <br /> DEPARTMENT OF LICENSING(DOL)CONTACT INFORMATION <br /> DOL Division DOL Administration <br /> Programs and Services Taxing and Fee Contracts <br /> Ir <br /> Contract Manager DOL Contact Address <br /> Jennifer Dana, Program Manager PO BOX 2076 <br /> Olympia WA, 98507-2076 <br /> Contract Manager telephone Contract Manager fax Contract Manager E-Mail <br /> 360-902-3673 360-570-7861 jedana@dolwa.gov <br /> 4° <br /> AUTHORITY <br /> in accordance with, RCW 36.73.065, RCW 39.34, RCW 46.17, RCW 82.80.140, WAC 308-10, Chapter 18 USC sec. .7� <br /> 2721-2725 Driver Privacy Protection Act(DPPA), and Executive Order 97-01, and all applicable laws as currently --r <br /> written or hereafter amended. <br /> ATTACHMENTS <br /> This following are attached and incorporated herein and/or by reference (Check all applicable) f <br /> ® A= General Terms and Conditions ® B = Statement of Work <br /> ® C =Vehicles Subject To Fees ® D=Vehicles Not Subject To Fees <br /> The terms and conditions of this Contract are an integration and representation of the final, entire and exclusive <br /> understanding between the parties superseding and cancel all previous agreements, writings, and communications, <br /> oral or otherwise regarding the subject matter of this Contract, between the parties. <br /> IN WITNESS WHEREOF, the parties have executed this Contract and affirm they have read and understand all terms <br /> and conditions of this Contract and have the authority to bind their respective parties to the terms and conditions of <br /> this Contract. <br /> Contractor Signatu e Date Signed DOL Signature Date VI <br /> or, <br /> Signed <br /> to—/'� n /� <br /> �' / /O -/e, -/ <br /> Print Na �d Title Pr�n ame and Title <br /> / <br /> Ray St - anson M issa Cox <br /> Mayor M nager DOL Contract Offi e <br /> a f pm h'1 -e- <br /> APPROVEU AS TO FORM <br /> • <br /> File Na e:!dnigS D. ILES, City Attorney <br /> Page 1 of 7 <br />